经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床疗效分析

摘要

目的 比较经鼻间歇正压通气(NIPPV)和持续正压通气(NCPAP)治疗新生儿呼吸窘迫综合征的有效性和安全性,并评估无创间歇正压通气模式在新生儿呼吸窘迫综合征中的应用价值.方法 采用2013年1月1日至2014年12月31日,在我科住院治疗的83例符合新生儿呼吸窘迫综合征诊断标准的新生儿,随机分为NIPPV组(n=41)与NCPAP组(n=42).比较两组患儿无创呼吸通气支持治疗1小时、12小时的PaCO2、氧合指数(OI)、无创通气失败而改为有创通气的例数、氧疗时间以及并发症发生率.结果 在无创呼吸机通气1h及12h时,NIPPV组PaCO2明显低于NCPAP组(P＜0.05),pH值、OI明显高于NCPAP组(P＜0.05);NIPPV组氧疗时间低于NCPAP组(P＜0.05);NIPPV组呼吸暂停、呼吸机相关性肺炎发生率和无创通气失败而改成有创通气率明显低于NCPAP组(P＜0.05).结论 NIPPV对于无明显无创通气禁忌症的NRDS早产儿,其临床效果优于传统的NCPAP,值得在临床推广应用.%Objective To compare the efficacy and safety of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS),and assess the application value of noninvasive intermittent positive pressure ventilation mode in NRDS.Methods 83 cases of NRDS treated in our department from 2013-1-1 to 2014-12-31 were randomly divided into NIPPV group (n=41) and NCPAP group (n=42).Compared the effectiveness of NIPPV and NCPAP in respiratory support treatment of NRDS for 1 hour,12 hours from the following aspects:reducing CO2 retention,improving oxygenation,reducing duration of invasive respiratory support,oxygen therapy time,and the incidence of complications between two groups.Results After 1 hour and 6 hours of noninvasive ventilator support,NIPPV group was superior to NCPAP group with respect to the reduction CO2 retention and the improvement in oxygenation (P＜0.05).The duration of invasive respiratory support,the duration of oxygen therapy of NIPPV group were less than those of NCPAP group (P＜0.05).The incidence of apnea and ventilator-associated pneumonia in NIPPV group were significantly less than those in NCPAP group during the treatment period (P＜0.05).Conclusion NIPPV is more effective and safer than NCPAP in the treatment of neonatal respiratory distress syndrome,worth popularizing in clinical.